Outcomes and patterns of failure for sinonasal undifferentiated carcinoma (SNUC): The Mayo Clinic Experience

Gamez, M.E.; Lal, Devyani; Halyard, Michele Y.; Wong, William W.; Vargas, Carlos; Ma, Daniel; Ko, Stephen; Foote, Robert L.; Patel, Samir H.

doi:10.1002/hed.24834

Cited by 48 publications

(33 citation statements)

References 18 publications

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“…More specifically, we found no prognostic difference between surgical approach or CRT as locoregional curative therapy. This is not in line with the literature data, [31][32][33] in which trimodality seems to be associated with better outcome in locoregional advanced cases. However, one should always consider the biases of treatment selection, which prompted a nonsurgical approach in diseases obtaining a favorable response to IC, thus bearing a better prognosis as recently reported by a retrospective U.S. series of SNUC.…”

Section: Discussioncontrasting

confidence: 91%

Locally advanced epithelial sinonasal tumors: The impact of multimodal approach

et al. 2019

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Objective Outcomes of locally advanced epithelial sinonasal cancers remain unsatisfactory; moreover, only limited and heterogeneous data exist on prognostic factors. Methods We reviewed all consecutive patients with American Joint Committee Cancer stage III to IV epithelial sinonasal cancers treated with platinum‐based induction chemotherapy (IC) followed by locoregional treatment between 1996 and 2015. Results We identified 69 patients treated with a multimodal approach (IC, surgery, radiotherapy). Overall, 44 patients recurred (64%). Of those, 19 patients received salvage surgery, but only four remained disease‐free. Median overall survival (OS) was 62.5 months. Sinonasal neuroendocrine and small cell histotypes (P = 0.0085), neuroendocrine differentiation (P = 0.006), and lack of response to IC (P = 0.03) were associated with worse OS. In patients who recurred, median OS was 13 months since recurrence. Survival was longer in patients submitted to salvage surgery (44%) than in those receiving chemotherapy alone at recurrence (29.5 vs. 4.6 months). Patients with a clinical benefit after palliative chemotherapy had a longer median OS than those with disease progression (29.2 vs. 4.4 months; P < 0.0001). Conclusion Globally, the prognosis of locally advanced epithelial sinonasal cancers is dismal, with worse outcomes for neuroendocrine lesions. In the recurrent setting, feasibility of salvage surgery and clinical benefit from palliative chemotherapy are associated with longer OS. A multimodal treatment strategy with IC seems to offer improved OS when compared with other retrospective series not employing such a therapeutic tool. Level of Evidence 4 Laryngoscope, 130:857–865, 2020

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Section: Discussioncontrasting

confidence: 91%

Locally advanced epithelial sinonasal tumors: The impact of multimodal approach

et al. 2019

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“…To the best of our knowledge, no randomized evidence to date has validated the optimal management of patients with NC or PNS malignancies, and anatomic constraints from adjacent critical structures pose challenges to both surgical and radiation‐based approaches. With photon RT, LC rates commonly have been estimated to be between 60% and 80% in the adjuvant setting and approximately 40% to 70% in the definitive setting, highlighting the difficulty in achieving local disease control with primary RT . It is known that high doses are required to control these tumors because local recurrence is the predominant mode of treatment failure .…”

Section: Discussionmentioning

confidence: 99%

Outcomes and toxicities of definitive radiotherapy and reirradiation using 3‐dimensional conformal or intensity‐modulated (pencil beam) proton therapy for patients with nasal cavity and paranasal sinus malignancies

Fan

Kang

Lee

et al. 2020

Cancer

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BACKGROUND: Proton therapy (PT) improves outcomes in patients with nasal cavity (NC) and paranasal sinus (PNS) cancers. Herein, the authors have reported to their knowledge the largest series to date using intensity-modulated proton therapy (IMPT) in the treatment of these patients. METHODS: Between 2013 and 2018, a total of 86 consecutive patients (68 of whom were radiation-naive and 18 of whom were reirradiated) received PT to median doses of 70 grays and 67 grays relative biological effectiveness, respectively. Approximately 53% received IMPT. RESULTS: The median follow-up was 23.4 months (range, 1.7-69.3 months) for all patients and 28.1 months (range, 2.3-69.3 months) for surviving patients. The 2-year local control (LC), distant control, disease-free survival, and overall survival rates were 83%, 84%, 74%, and 81%, respectively, for radiation-naive patients and 77%, 80%, 54%, and 66%, respectively for reirradiated patients. Among radiation-naive patients, when compared with 3-dimensional conformal proton technique, IMPT significantly improved LC (91% vs 72%; P < .01) and independently predicted LC (hazard ratio, 0.14; P = .01). Sixteen radiation-naive patients (24%) experienced acute grade 3 toxicities; 4 (6%) experienced late grade 3 toxicities (osteoradionecrosis, vision loss, soft-tissue necrosis, and soft tissue fibrosis) (grading was performed according to the National Cancer Institute Common Terminology Criteria for Adverse Events [version 5.0]). Slightly inferior LC was noted for patients undergoing reirradiation with higher complications: 11% experienced late grade 3 toxicities (facial pain and brain necrosis). Patients treated with reirradiation had more grade 1 to 2 radionecrosis than radiation-naive patients (brain: 33% vs 7% and osteoradionecrosis: 17% vs 3%). CONCLUSIONS: PT achieved remarkable LC for patients with nasal cavity and paranasal sinus cancers with lower grade 3 toxicities relative to historical reports. IMPT has the potential to improve the therapeutic ratio in these malignancies and is worthy of further investigation. Cancer 2020;126:1905-1916.

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“…The final selection of the relevant studies involved an extensive screening of the selected articles by going through the abstracts and the full text studies in doubt. After full-text revision, 12 articles, 10,13,[19][20][21][22][23][24][25][26][27][28] all published in English with 255 participants were selected for final evaluation. Eight studies 8 were conducted in the USA, while one study was performed in Switzerland, Spain, India, and France, respectively.…”

Section: Search Findingsmentioning

confidence: 99%

“…However, trimodal treatment regimens, including surgery, radiotherapy, and chemotherapy are associated with improved outcome compared to bimodal approaches. 13,14 Moreover, due to the complex anatomical location of these tumors and the advanced tumor stages 14 in the majority of cases at time of diagnosis, surgical treatment concepts often requiring combined endoscopic and open craniofacial approaches, have mainly focused on radical tumor resection with clear resection margins and good local control. Consequently, the issue of elective neck treatment, and of elective neck dissection (END) in particular, has been usually neglected and not been addressed in initial therapy.…”

Section: Introductionmentioning

confidence: 99%

Elective neck treatment in sinonasal undifferentiated carcinoma: Systematic review and meta‐analysis

Faisal¹,

Seemann²,

Lill³

et al. 2020

Head & Neck

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Sinonasal undifferentiated carcinomas (SNUCs), being an aggressive malignancy with dismal survival outcome, have given limited consideration regarding management of regional failures. A total of 12 studies, published between 1999 and 2019, met inclusion criteria. We performed a meta-analysis assessing regional (neck) relapse after elective neck treatment compared to observation in clinically node negative (N0) necks. Clinical data of 255 patients were used for meta-analysis. Among them, 83.4% of patients presented with T4 tumors and 14.1% had positive neck nodes. Elective neck treatment was applied in 49.5% of analyzed patients. Regional relapses occurred in 3.7% of patients who have undergone elective neck treatment compared to 26.4% in patients who had not. Elective neck treatment significantly reduced the risk of regional recurrence (odds ratio 0.20; 95% confidence interval 0.08-0.49; P = .0004). The meta-analysis indicates that elective neck treatment could significantly reduce the risk of regional failures in patients with SNUCs. K E Y W O R D Selective neck dissection, elective neck treatment, regional relapse, sinonasal undifferentiated carcinoma, SNUC

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Outcomes and patterns of failure for sinonasal undifferentiated carcinoma (SNUC): The Mayo Clinic Experience

Abstract: SNUC is an aggressive malignancy with a high tendency to metastasize. Better outcomes were obtained with a trimodality approach. Modern radiotherapy (RT) techniques and doses ≥ 60 Gy were associated with improved OS.

Cited by 48 publications

References 18 publications

Locally advanced epithelial sinonasal tumors: The impact of multimodal approach

Locally advanced epithelial sinonasal tumors: The impact of multimodal approach

Outcomes and toxicities of definitive radiotherapy and reirradiation using 3‐dimensional conformal or intensity‐modulated (pencil beam) proton therapy for patients with nasal cavity and paranasal sinus malignancies

Elective neck treatment in sinonasal undifferentiated carcinoma: Systematic review and meta‐analysis

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